Category Archives: Suicide Assessment and Intervention

The Montana Suicide Assessment and Treatment Planning Model is Coming to a Location Near You

While hanging out on Twitter, I noticed that E. David Klonsky, a fancy suicide researcher from the University of British Columbia tweeted about a brand new article published in the Journal of Affective Disorders.

The article, titled, “Rethinking suicides as mental accidents” makes a case for what the authors (Drs Ajdacic-Grossab, Hepp, Seifritz, and Bopp from Switzerland) refer to as the starting point for a “Rethink.”

Aside from their very cool use of the term rethink—a term I’m planning to adopt and overuse in the future—the authors’ particular “rethink” has to do with reformulating completed suicides as mental accidents, instead of mental illness. They concluded, “The mental accident paradigm provides an interdisciplinary starting point in suicidology that offers new perspectives in research, prediction and prevention” (p. 141).

For those of you who follow this blog and know me a bit, it will come as no surprise that I commend the authors for moving away from the term mental illness, but that I also think they should move even further away from even the scent of pathologizing suicidal thoughts and behaviors.

All this brings me to an important announcement.

Starting on the evening of May 16 and continuing onto May 17, in partnership with the Big Sky Youth Empowerment Project (thanks Pete and Katie), I’ll begin the launch of some public and professional suicide trainings in Montana. These trainings will include evening public lectures (starting May 16 in Bozeman) and professional trainings on suicide assessment and treatment planning (starting May 17 in Bozeman).

Going back to the “rethink” of suicide as a mental accident, I want to emphasize that my goal with these lectures and workshops is to reshape discussions about suicide from illness-focused to health and wellness focused. Rethink of it as a strength-based approach to suicide assessment and treatment planning. And you can also rethink of it as no accident.

For more information on the public lecture, check out this flyer: BYEPSAWpublic (1)

For more information on the professional suicide assessment and treatment planning workshop, check out this link: https://go.byep.org/advances and flyer: BYEPSAWclinical (1)

And if you can’t make these events, no worries, as I mentioned, this is a launch . . . which means there’s more coming later this year . . . in Billings, in Great Falls, and in Missoula.

Finally, if you want a workshop like this in your city, let me know. The good people of Big Sky Youth Empowerment are committed to delivering a more positive message about suicide assessment and treatment planning to other locations around the state; maybe we can partner up and do some important work together.

Thanks for reading and happy Sunday evening!

data or data

Suicide Assessment and Treatment Planning: Resources for Professionals

The Road

As you probably know, suicide rates are and have been on the rise. Here’s what the Centers for Disease Control said several months ago: “From 1999 through 2017, the age-adjusted suicide rate increased 33% from 10.5 to 14.0 per 100,000” (CDC, November, 2018).

Although the CDC’s report of a 33% increase in the national suicide rate is discouraging, the raw numbers are even worse. In 1999, an estimated 29,180 Americans died by suicide. As a comparison, in 2017 (the latest year for which data are available), there were 47,173 suicide deaths. This represents a 61.9% rise in the raw number of suicide deaths over the past 17 years.

Along with rising suicide rates, there’s also a palpable rise in anxiety and panic among mental health and healthcare professionals, teachers, and the public. Even though suicides still occur at a low rate (14 per 100,000), it’s beginning to feel like a public health crisis. We don’t have much evidence that current intervention and prevention efforts are working, and the continued tragic outcomes (about 129 suicide deaths each day in the U.S.) are painful and frustrating.

The purpose of this post is simply to offer resources. I’ve been working in this area for many years; my sense is that having additional resources to help professionals feel more competent can reduce anxiety and probably increases competence. Here are some resources that might be helpful.

  1. In 2018 I published an article in the Journal of Health Service Psychology. The purpose of the article was to provide clear ideas about how psychological providers can be more effective in how they work with clients or patients who are suicidal. You can click here to access a pdf of the article. Conversations About Suicide by JSF 2018
  2. I’ve been working with some of my doctoral students on alternatives to the traditional (and failed) approach of using client risk factors to categorize or estimate suicide risk. One product of this work is an evidence-based list of eight potential suicide dimensions. These suicide dimensions can be used with other models (e.g., safety planning) to guide collaborative treatment planning. To see a description of the eight dimensions and a treatment planning form based on the eight dimensions, you can click on the following links. Suicide TPlanning Handout            Suicide TPlanning Handout Blank
  3. Barbara Stanley and Gregory Brown developed the “Safety Planning Intervention.” For information about their intervention and access to their safety planning form, you can go to their website: http://suicidesafetyplan.com/Home_Page.html
  4. Along with Victor Yalom and some other contributors, this past year I helped produce a 7.5 hour professional training video titled, Assessment and Intervention with Suicidal Clients. You can buy this 3-part video series through Psychotherapy.net and can access a preview of the video series here: http://www.psychotherapy.net/video/suicidal-clients-series
  5. I’m a big fan of David Jobes’s work on the collaborative assessment and management of suicide. You can check out his book on Amazon: https://www.amazon.com/Managing-Suicidal-Risk-Second-Collaborative/dp/146252690X/ref=sr_1_1?crid=29DN6ZM2BUCV3&keywords=david+jobes+suicide&qid=1551837394&s=gateway&sprefix=david+jobes%2Caps%2C177&sr=8-1
  6. Later this spring and this fall, in collaboration with the Big Sky Youth Empowerment Program and the University of Montana, I’ll be offering several low-cost six-hour training workshops in four different Montana locations. These trainings will include research data collection, as well as an opportunity to participate in follow up booster trainings—booster sessions that will happen about three months after you attend an initial six-hour session. If you’re interested in participating in these Montana Suicide Assessment and Treatment Planning Workshops, you can email me, send me your email via a comment on this blog, or begin following this blog so you don’t miss out when I share the dates, times, and locations, and registration information in an upcoming post.

I hope this information is helpful to you in your work with clients struggling with suicide. Together, hopefully we can make a difference.

Advances in Suicide Assessment and Treatment . . . just published in the Jubilee Edition of Psychology Aotearoa

Ocean View

Here’s the view from New Zealand.

The professional journal, Psychology Aotearoa is the flagship publication of the New Zealand Psychological Society. Just yesterday I received a copy of the Jubilee Edition of the journal. I’ve got a brief article on pp. 76-80, but the whole journal is an interesting glimpse of psychology, psychotherapy, and counseling at an international level. Here’s the pdf: 2018 November JSF New Zealand Pub

The Case Against Zero Suicide

SunsetI’ve been trying to find a way to say this nicely. Finally, I discovered a recent article in the Journal of the American Medical Association (JAMA) that says what I want to say—at least in part—in a more professional tone. The article is “Implications of Zero Suicide for Suicide Prevention Research.” Spoiler alert, the authors, Dominic Sisti, Ph.D. and Stephen Joffe, M.D. end their article with the following sentence: “To demonstrate which interventions are effective for reducing the suicide epidemic, it is necessary to let go of the belief that every suicide is preventable.” For their whole article, go to: https://jamanetwork.com/journals/jama/fullarticle/2706416?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=102318

I have no doubt that my views are more extreme that Drs Sisti and Joffe. They’re medical researchers, publishing in JAMA. But I was heartened by their article; it helped me feel less alone in my dislike for the idea of Zero Suicide. They inspired me to share some of my thoughts and writing on the topic.

That said, now I’m sharing an unpublished rant about Zero Suicide. As you read this, keep in mind that I’m strongly in favor of suicide intervention and suicide prevention. I’ve even started a trade book proposal on the subject. But I’m not in favor of Zero Suicide. Here’s why:

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Last month I entered into a Twitter debate about Zero Suicide. It started and ended like most Twitter debates. We disagreed in the beginning. Then, after several passionate exchanges, we disagreed even more in the end.

The issue was Zero Suicide. Zero Suicide is a national suicide prevention campaign, healthcare philosophy, and comfortable delusion. In case you haven’t yet heard of Zero Suicide, there’s a Zero Suicide Academy, Zero Suicide ToolKit, Zero Suicide Community, and several websites orienting people to the Zero Suicide Initiative. As a pragmatic mental health professional and sentient human being, I’m completely in favor of suicide prevention. I’m in favor of suicide prevention because many people who think about suicide are in great psychological pain, and if that pain can be addressed, then their suicide wishes often can abate. I also support much of what the various Zero Suicide Initiative involves. However, as a behavioral scientist and someone who has regular contact with other humans, I consider Zero Suicide to be a ridiculous philosophy and a DUMB goal.

Zero Suicide is a DUMB goal, principally because it’s the opposite of a SMART goal. You can find definitions of SMART goals all over the internet. SMART goals are commonly attributed to Peter Drucker—a renowned management consultant, Austrian immigrant, and author of 39 books. Drucker is commonly considered one of the most important thought leaders in business management. Using Drucker’s principles, back in 1981, George T. Doran published a paper in Management Review titled, There’s a S.M.A.R.T. way to write management’s goals and objectives. Although many variations exist, SMART goals are typically defined as:

S =  Specific

M = Measurable

A = Achievable or Assignable

R = Relevant or Realistic

T = Time-bound

Drucker and Doran were writing from a business management perspective, but smart goals are also intrinsic to psychotherapy. I won’t be going into the details here, but William Glasser and Robert Wubbolding, two renowned reality therapists, describe important variations of smart goals in psychotherapy. Put simply, the philosophy of Glasser and Wubbolding is simply common sense: “A goal should be within your control.” Put differently, if individuals or agencies identify goals that are dependent on other people’s behavior, then frustration and other problems will inevitably ensue.

Online resources for Zero Suicide are impressive. The breadth and volume of information will provide healthcare professionals with an excellent foundation for working with suicidal patients. For the most part, I have few objections to the quality and quantity of their online suicide prevention resources. Having these resources for healthcare professionals and the general public is important and fantastic. With a foundation of knowledge and informed action, it’s possible to prevent some, but not all suicides.

Despite its impressive array of information, Zero Suicide also has several shortcomings. For example, nowhere on their 66 item Zero Suicide Workforce Survey do they ask a question about having or holding empathy or compassion for suicidal patients. Empathy and compassion needs continual re-emphasis in suicide prevention. Why? Because patients, clients, and citizens who are suicidal, are also often experiencing depressive symptoms. All helpers and healthcare professionals should understand that empathic responding is the foundation of suicide intervention and prevention. Even further, one common depressive symptom is irritability. If irritability is present (along with depression and suicidal thoughts, when healthcare workers or others try to intervene with suicidal people—or persuade them to get help—the following pattern might emerge.

Gloria: I’m concerned about you and how you’re doing. “Have you been thinking about suicide?”

Sean: Yes. I think about it all the time.

Gloria: I want to tell you that there are some excellent resources available for people who are feeling suicidal.

Sean: I know that.

Gloria: Can I get you connected with a counselor here in town?

Sean: Not interested.

Gloria: But I want to be of some help to you, in some way.

Sean: I don’t want your pitiful help. I’m depressed and I’ve been thinking about suicide. I’ve been to counselors. Nothing helps.

Gloria: How about friends? Do you have some friends who might help and support you?

Sean: None of my friends care anymore.

Gloria: How about family?

Sean: My family has disowned me and I’ve disowned them.

Gloria: How about a church or community center? Lots of people get support at those places.

Sean: I can’t hardly get myself out of the house, so those are stupid ideas.

Gloria: Have you tried medications?

Sean: Medications just make me feel worse.

Gloria: How about exercise?

Sean: Seriously?

At this point in the conversation Gloria probably feels frustrated. She’s trying to help, but she can feel Sean resisting her efforts. Gloria is problem-solving, but Sean is feeling hopeless and isn’t able to engage in the problem-solving process. Sean has been through all these ideas in his head and in his depressive state of mind, he’s already rejected all these ideas as completely ineffective.

Next up, Gloria might up the ante by trying to get Sean to engage in logical thinking. She might say something like, “Suicide is a permanent solution to a temporary problem.” Having heard this logical ploy several times, Sean will be ready, “I’ve been living in misery for years. You might see the world as all happy and shit with your fancy shoes and Polly-Anna glasses on, but what I’m experiencing doesn’t feel temporary. I hate my life and I want to die.”

Even if Gloria is more saint-like than most, it will be difficult for her to sustain a helpful attitude toward Sean. She might try encouraging him to go to the hospital, but many suicidal people abhor the idea of hospitalization. Eventually, as Sean continues to insist that he’s suicidal, she might call for a county mental health professional to conduct an evaluation. If so, Sean may lie to the evaluator and say that he’s not imminently suicidal or the evaluator may decide Sean isn’t suicidal. Or, in the best case scenario, Sean may be hospitalized, but he also is likely to become very pissed off at Gloria, because he views her as usurping his personal rights and freedoms. In nearly every case, people like Sean are not likely to pause and thank Gloria for her suicide prevention efforts.

I could go on, but I’d probably just head further down this dark road. Instead, I’ll try to end with a few hopeful comments.

Suicide prevention is important, but it’s part of a strange dialectic. Sometimes, if we try hard to connect with someone and save them, we are fabulously successful. However, other times we try to connect and the person rejects us and suicide becomes even more likely. What’s the difference? I don’t know the perfect answer, but I’m pretty sure it involves collaboration and not coercion. I wish I had thought this up myself, but it’s something that suicidologists, researchers, and philosophers have known for millennia. On top of being fantastically unrealistic, zero suicide also smacks of coercion.

One of the best and forward thinking suicide intervention researchers is Marsha Linehan. You may have heard of her because she’s a University of Washington professor and developer of Dialectical Behavior Therapy. I’ll end with a rather amazing piece that she wrote. Take some time to read it and try to absorb the message. I think her story is all about being empathic and collaborative. Let me know if you think so too. Here are Marsha Linehan’s words, from the Foreword of a book titled, “Building a Therapeutic Alliance with the Suicidal Patient.”

I always tell my students a story about what it is like to work with suicidal individuals. In the story, I describe the suicidal person as trapped in a small, dark room with no windows and high walls (in my mind always with stark white walls reaching very, very high). The room is excruciatingly painful. The person searches for a door out to a life worth living but, alas, cannot find it. Scratching and clawing on the walls does no good. Screaming and banging brings no help. Falling to the floor and trying to shut down and feel nothing gives no relief. Praying to God and all the saints one knows brings no salvation. The only door out the individual can find is the door to death. The task of the therapist in this situation, as I always tell my clients also, is to somehow find a way to get into the room with the person, to see the person’s world from his or her point of view; to get inside the person, so to speak, and then together search again for that door to life that the therapist knows must be there.

Last Call for the Suicide Assessment and Intervention Psychotherapy.net Video Training

Hi All.

Below is the link for the $139 deal for the 7.5 hour Assessment and Intervention with Suicidal Clients training video with Psychotherapy.net.

Please share this information with other professionals who might want or need to sharpen their skills for working with clients who are or might become suicidal. This is a hard topic and I hope this resource can help clinicians feel more confident and competent in their suicide assessment and intervention skills.

https://academy.psychotherapy.net/p/suicide-promo?utm_source=ActiveCampaign&utm_medium=email&utm_content=LAST+CHANCE%3A+Suicide+Assessment+and+Intervention&utm_campaign=suicide+course+email%233

 

 

Assessment and Intervention with Suicidal Clients: A Brand New 7.5 Hour Video Training

Yellow Flowers

Suicide rates in the U.S. are at a 30 year high. Beginning in 2005, death by suicide in America began rising, and it hasn’t stopped, rising for 12 consecutive years.

Worldwide (and at the CDC) suicide rates are tracked using the number of deaths per 100,000 individuals. Although the raw numbers listed above are important (and startling), calculating deaths per 100,000 individuals provides a consistent per-capita measure that allows for systematic comparison of suicide rates across different populations, geographic regions, sexual identity, seasons of the year, and other important variables. For 2000, the CDC reported an unadjusted death by suicide rate of 10.4 persons per 100,000. For 2016, they reported 13.7 suicides per 100,000 Americans. This represents a 31.7% increase over 16 years.

As suicide rates have risen, federal, state, and local officials haven’t been idly standing by, wringing their hands, and wondering what to do. To the contrary, they’ve been actively engaged in suicide prevention. In 2001, the Surgeon General established the first National Suicide Prevention Strategy, revising it in 2012. All the while, there have been big pushes by federal and state governments, community organizations, schools, private businesses, and nonprofits to fund and promote suicide prevention programming. For the most part, the suicide specialists who run these programs are fantastic. They’re dedicated, knowledgeable, and passionate about saving lives. In addition to all the prevention programs available today, currently there are more evidence-based psychotherapies for suicidal people than ever before in the history of time.

But even in the face of these vigorous suicide prevention and intervention efforts, suicide rates continue to relentlessly rise . . . at an average rate of nearly 2% per year.

At this point it’s clear that prevention efforts may not have a direct influence on overall suicide rates. It’s tough to move the big needle that measures U.S. suicide rates. Some solutions may be more sociological and political. Of course, that doesn’t mean we should stop doing prevention. But, given the numbers, it’s important for us to try to find alternative methods for reducing and preventing suicide.

All this leads up to an announcement. Today, Psychotherapy.net published a three volume 7.5 hour video training titled, Assessment and Intervention with Suicidal Clients. This project was a collaboration between Rita, me, and Victor Yalom (along with his amazing staff at Psychotherapy.net). Although watching this video won’t automatically make suicide rates decrease, gaining awareness, knowledge, and skills on suicide assessment and intervention is one way counselors and psychotherapists can contribute to suicide prevention.

Psychotherapy.net is offering an introductory offer for the 7.5 hour video, with CEUs included. You can click here for details on the introductory offer and a sneak peek at the video.

I hope you find the video training helpful, and I look forward to hearing comments and feedback from you about how we can keep working together to help prevent suicide.

Aotearoa New Zealand Conference Keynote

NZ Tree and John

Kia ora.

Today is the future in New Zealand where I have the distinguished and humbling honor to present the closing keynote speech at the New Zealand Psychological Society’s Jubilee Conference.

Attached here are two things:

  1. The Brainstormed powerpoint slides from my workshop last Wednesday. These include a list of resources that New Zealand professionals and students have found useful in their suicide assessment, intervention, and prevention work. NZ 2018 Workshop Brainstorming
  2. The powerpoint slides for today’s keynote:NZ 2018 Suicide Keynote Final